Covid19 Form

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Airmatics Covid 19 Form

In line with NSW government requirements please fill out the below form. This information will only be used for contact tracing purposes if required.
If you answer yes to any of the questions you will not be granted entry. This form is time stamped so please fill out the form immediately before gaining entry.

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Expected duration of visit *

Are you currently displaying flu like symptoms *

Yes No

Have you travelled from/visited in the last 14 days Overseas, the state of Victoria or any other local confirmed Coronavirus hotspots *

Yes No

In the last 14 days have you been diagnosed with Coronavirus *

Yes No

In the last 14 days have you come in contact with someone with a confirmed case of Coronavirus *

Yes No

Have any members of your household been diagnosed with Coronavirus, currently awaiting a Coronavirus test result, self isolating due to either international/interstate travel, visiting a local Coronavirus hot spot or been in contact with another person with Coronavirus. *

Yes No

Are you currently under a quarantine or self isolation health order due to travel or awaiting results for a Coronavirus test *

Yes No

I have answered the above questions honestly and to the best of my knowledge. While on site I will practise and maintain correct hygiene and social distancing. If asked to leave by staff due to failing to follow correct hygiene/ social distancing practices I will do so immediately. *

I agree

Submit

* Indicates required field

Name *

First

Last

Email *

Comment *

Submit

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